Written by

Shelley DuBois

The Tennessean

Robert Chamberlain and Eliot Houser are serious about wellness — so serious, in fact, that they try to avoid the term. Their company, Applied Health Analytics, sells employers evidence-based services designed to help improve what the two men call “population health.”

The company’s bread and butter is a tech product developed by Houser, who is Applied Health Analytics’ chief information officer. The trick to turning an algorithm into actual behavioral changes, said CEO Chamberlain, is that the company also partners with local health providers to track how workers participate in programs and receive care.

Houser and Chamberlain founded Applied Health Analytics in 2009 via a joint venture with Vanderbilt University. Vanderbilt, in exchange for access to the company’s intellectual property, receives equity.

Houser and Chamberlain sat down with Tennessean reporter Shelley DuBois to talk about the hard data behind the soft science of “wellness” and where to find brilliant, geeky programmers in Nashville.

What is the science behind convincing people to be healthier?

Robert Chamberlain: We keep it very simple. There are three areas that you need to focus on to have evidence-based wellness. One is behavior modification, which means weight management, physical activity, nutrition, medication adherence and things like that. Second are emotional issues, largely around stress, depression and sleep disorders. The third one is making sure that people are participating in CDC-recommended screenings and examinations. So if employers will just focus on those three areas, it’s pretty much everything they can do to enhance health.

That is a very analytical look at something such as wellness, which is usually considered a soft science.

Eliot Houser: That’s why we try not to use the word “wellness.”

RC: Wellness is water bottles and T-shirts and, you know, peppy young ladies in the HR department who once a year tote this thing out, and six weeks later the grumpy old men are back at their desks saying, “I’m not going to do that again.” No, this is moving into population health. It’s about how do we up the science of this game, how do we better risk-stratify? How do we engage, how do we measure?

But if I’m a night nurse in a rural town and you tell me to join your smoking cessation program because it will save my company money, I’m going to tell you to buzz off. How do you attract employees to evidence-based programs?

RC: There are two things. One is the employer’s commitment to creating a culture of health — it’s not just the initiative du jour. It’s saying to that workforce, “This is part of our environment. This is what we’re all about. We’re going to make a commitment to this, and we’re going to talk with our checkbook.” Which is the second thing. We’re seeing employers get very, very aggressive in aligning financial incentives with behavior change.

Take my favorite company, Charlotte Pipe & Foundry in Charlotte, N.C. It has 1,200 employees, it’s self-funded and headed up by a very visionary management team. When you go to work at Charlotte Pipe & Foundry, you’re employed for generations — so very family-oriented. Roddey Dowd, who’s the CEO, is the first guy in line at the biometric assessment. He’s showing his employees, “I’m part of this as well.” They’ve set up what we call a metrics-based incentive design that incents BMI management. Participants have to show progress in terms of their blood pressure, cholesterol level, glucose management and tobacco use. If you show improvement in all of those — and it’s not “go from morbidly obese to donning spandex and riding 10-speeds,” it really is just “show improvement” — there’s a $1,250 bonus and a 20 percent reduction in the family health premium.

That kind of money should get people’s attention.

EH: But also, built into our program is a coaching platform. A big part of the coaching platform is identifying what motivates people. People are thinking about today — their problems and stresses and family lives. So you ask them questions like, “Where would you like to be 20 years from now?” And they say, “Well, I would like to be retired and living on the beach and spending time with my three grandkids.” The interviewer could say, “Well, having a BMI of 32 and being a smoker, chances are, that’s not the future you’re going to have.”

You start to change the perception. You say, “If this is your vision, you have to realize that what you do now is going to affect the possibility of getting to your vision.”

RC: The future of health care is very much based on coaching. In fact, we’re working again with Vanderbilt School of Nursing to help them construct a coaching curriculum for incoming students about motivational interviewing techniques. So that when you take a look at these at-risk individuals, you can apply a technique that will connect with that specific person.

EH: Yes. Within our software, we have an option for feature requests and we get those all the time. People will say, “Oh, it’d be really good if it did this,” and they type it right into our software — it’s very prominent.

RC: Here’s the genius of Eliot Houser — he bucks all the IT trends. We’re developing an open-source, scripted language. And we have very brilliant — in-house, by the way — individuals who, even when they go home, they’re writing their own programs. They take great pride in calling themselves geeks.

I heard that there was a dearth of tech-savvy programmers in Nashville.

EH: We’re not finding that. In fact, we’re finding our people on Craigs­list.

RC: And they attract each other. When we bring somebody on board, everybody interviews them and if he or she has geek status, they’re in. You know, they need to watch “The Big Bang Theory” and wear crazy T-shirts.